Models and methods for determining the optimal number of beds in hospitals and regions: a systematic scoping review.

BACKGROUND: Determining the optimal number of hospital beds is a complex and challenging endeavor and requires models and techniques which are sensitive to the multi-level, uncertain, and dynamic variables involved. This study identifies and characterizes extant models and methods that can be used to determine the required number of beds at hospital and regional levels, comparing their advantages and challenges. METHODS: A systematic search was conducted using Web of Science, Scopus, Embase and PubMed databases, with the search terms hospital bed capacity, hospital bed need, hospital, bed size, model, and method. RESULTS: Twenty-three studies met the criteria to be included in the review. Of these studies, a total of 11 models and 5 methods were identified, mainly designed to determine hospital bed capacity at the regional level. Common determinants of the required number of hospital beds in these models included demographic changes, average length of stay, admission rates, and bed occupancy rates. CONCLUSIONS: There are no specific norms for the required number of beds at hospital and regional levels, but some of the identified models and methods may be used to estimate this number in different contexts. Moreover, it is important to consider alternative approaches to planning hospital capacity like care pathways to fix the limitations of "bed numbers".

Barriers to Regionalized Surgical Care: Public Perspective Survey and Geospatial Analysis.

OBJECTIVE: To describe public willingness to participate in regionalized surgical care for cancer. SUMMARY OF BACKGROUND DATA: Improved outcomes at high-volume centers following complex surgery have driven a push to regionalize surgical care. Patient attitudes toward regionalization are not well described. METHODS: As part of the Cornell National Social Survey, a cross-sectional telephone survey was performed. Participants were asked about their willingness to seek regionalized care in a hypothetical scenario requiring surgery. Their responses were compared with demographic characteristics. A geospatial analysis of hospital proximity was performed, as well as a qualitative analysis of barriers to regionalization. RESULTS: Cooperation rate was 48.1% with 1000 total respondents. They were an average of 50 years old (range 18 to 100 years) and 48.9% female. About 49.6% were unwilling to travel 5 hours or more to seek regionalized care for improved survival. Age >70 years [odds ratio (OR) 0.34, 95% confidence interval (95% CI) 0.19-0.60] and perceived distance to a center >30 minutes (OR 0.60, 95% CI 0.41-0.86) were associated with decreased willingness to seek regionalized care, while high income (OR 2.09, 95% CI 1.39-3.16) was associated with increased willingness. Proximity to a major center was not associated with willingness to travel (OR 0.92, 95% CI 0.67-1.22). Major perceived barriers to regionalization were transportation, life disruption, social support, socioeconomic resources, poor health, and remoteness. CONCLUSION: Americans are divided on whether the potential for improved survival with regionalization is worth the additional travel effort. Older age and lower income are associated with reduced willingness to seek regionalized care. Multiple barriers to regionalization exist, including a lack of knowledge of the location major centers.

The impact of patient preferences and costs on the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.

BACKGROUND: Although the delivery of appropriate healthcare is an important goal, the definition of what constitutes appropriate care is not always agreed upon. The RAND/UCLA Appropriateness Method is one of the most well-known and used approaches to define care appropriateness from the clinical perspective-i.e., that the expected effectiveness of a treatment exceeds its expected risks. However, patient preferences (the patient perspective) and costs (the healthcare system perspective) are also important determinants of appropriateness and should be considered. METHODS: We examined the impact of including information on patient preferences and cost on expert panel ratings of clinical appropriateness for spinal mobilization and manipulation for chronic low back pain and chronic neck pain. RESULTS: The majority of panelists thought patient preferences were important to consider in determining appropriateness and that their inclusion could change ratings, and half thought the same about cost. However, few actually changed their appropriateness ratings based on the information presented on patient preferences regarding the use of these therapies and their costs. This could be because the panel received information on average patient preferences for spinal mobilization and manipulation whereas some panelists commented that appropriateness should be determined based on the preferences of individual patients. Also, because these therapies are not expensive, their ratings may not be cost sensitive. The panelists also generally agreed that preferences and costs would only impact their ratings if the therapies were considered clinically appropriate. CONCLUSIONS: This study found that the information presented on patient preferences and costs for spinal mobilization and manipulation had little impact on the rated appropriateness of these therapies for chronic low back pain and chronic neck pain. Although it was generally agreed that patient preferences and costs were important to the appropriateness of M/M for CLBP and CNP, it seems that what would be most important were the preferences of the individual patient, not patients in general, and large cost differentials.

Using geographic information systems to map older people's emergency department attendance for future health planning.

OBJECTIVES: This study aimed to assess the pattern of use of EDs, factors contributing to the visits, geographical distribution and outcomes in people aged 65 years or older to a large hospital in Dublin. METHODS: A retrospective analysis of 2 years of data from an urban university teaching hospital ED in the southern part of Dublin was reviewed for the period 2014-2015 (n=103 022) to capture the records of attenders. All ED presentations by individuals 65 years and older were extracted for analysis. Address-matched records were analysed using QGIS, a geographic information systems (GIS) analysis and visualisation tool to determine straight-line distances travelled to the ED by age. RESULTS: Of the 49 538 non-duplicate presentations in the main database, 49.9% of the total are women and 49.1% are men. A subset comprised of 40 801 had address-matched records. When mapped, the data showed a distinct clustering of addresses around the hospital site but this clustering shows different patterns based on age cohort. Average distances travelled to ED are shorter for people 65 and older compared with younger patients. Average distances travelled for those aged 65-74 was 21 km (n=4177 presentations); for the age group 75-84, 18 km (n=2518 presentations) and 13 km for those aged 85 and older (n=2104 presentations). This is validated by statistical tests on the clustered data. Self-referral rates of about 60% were recorded for each age group, although this varied slightly, not significantly, with age. CONCLUSIONS: Health planning at a regional level should account for the significant number of older patients attending EDs. The use of GIS for health planning in particular can assist hospitals to improve their understanding of the origin of the cohort of older ED patients.

Regional initiatives for malaria elimination: Building and maintaining partnerships.

Andrew Lover and colleagues discuss regional malaria initiatives, the strengths and challenges.

[Regional ophthalmological cluster as a resource basis for the process and the procedure of specialist accreditation]. / Regional'nyi oftal'mologicheskii klaster kak osnova resursnogo obespecheniia protsessa i protsedury akkreditatsii vrachei.

Since 2016, phased introduction of specialist accreditation has been launched. Many issues like how training at regional accreditation centers (RACs) should be organized - for applicants applying for primary specialized accreditation as residents in ophthalmology (2018) or periodic accreditation as practicing ophthalmologists (2021) - are yet debatable. AIM: to provide organizational and educational resources for arranging accreditation of ophthalmologists at the background of improving the quality of medical care in a federal subject of the Russian Federation. MATERIAL AND METHODS: The study object was the process and the procedure of accreditation, the study subject - the system of specialist accreditation. METHODS: bibliographical, analytical, and expert. Methodological basis for tasks solving: mobilization of an independent organizational structure, that is, the regional ophthalmological scientific-educational cluster (ROSEC). RESULTS: Three complex problems have been defined that require solution. 1. Discrepancies between accreditation procedures depending on the type of accreditation. The absence of practical skills assessment within the periodical accreditation procedure and low availability of innovative simulation systems impede the achievement of the declared goals of accreditation. 2. The absence of a clear order and criteria for portfolio assessment as well as a legal format of its formation during non-interrupted medical education (NIME) demands active management. 3. There is still a lack of appropriate organizational, educational, material technical, and personnel support of the accreditation system. The proposed organizational and methodological approaches are aimed at solving issues of accreditation support, proper functioning of RACs, and improving the quality and regional availability of NIME. CONCLUSION: Systematic approach effectively solves the problem of resource support of accreditation. ROSEC should be regarded as the provision basis for complex of all stages of ophthalmologist accreditation and proper functioning of RACs. ROSEC involvement is highly advisable.

Regionalization of Emergent Vascular Surgery for Patients With Ruptured AAA Improves Outcomes.

OBJECTIVE: Safe and efficient endovascular aneurysm repair (EVAR) for ruptured abdominal aortic aneurysm (r-AAA) requires advanced infrastructure and surgical expertise not available at all US hospitals. The objective was to assess the impact of regionalizing r-AAA care to centers equipped for both open surgical repair (r-OSR) and EVAR (r-EVAR) by vascular surgeons. METHODS: A retrospective review of all patients with r-AAA undergoing open or endovascular repair in a 12-hospital region. Patient demographics, transfer status, type of repair, and intraoperative variables were recorded. Outcomes included perioperative morbidity and mortality. RESULTS: Four hundred fifty-one patients with r-AAA were treated from 2002 to 2015. Three hundred twenty-one patients (71%) presented initially to community hospitals (CHs) and 130 (29%) presented to the tertiary medical center (MC). Of the 321 patients presenting to CH, 133 (41%) were treated locally (131 OSR; 2 EVAR) and 188 (59%) were transferred to the MC. In total, 318 patients were treated at the MC (122 OSR; 196 EVAR). At the MC, r-EVAR was associated with a lower mortality rate than r-OSR (20% vs 37%, P = 0.001). Transfer did not influence r-EVAR mortality (20% in r-EVAR presenting to MC vs 20% in r-EVAR transferred, P > 0.2). Overall, r-AAA mortality at the MC was 20% lower than CH (27% vs 46%, P < 0.001). CONCLUSIONS: Regionalization of r-AAA repair to centers equipped for both r-EVAR and r-OSR decreased mortality by approximately 20%. Transfer did not impact the mortality of r-EVAR at the tertiary center. Care of r-AAA in the US should be centralized to centers equipped with available technology and vascular surgeons.

Challenges of Recruitment and Retention in Rural Areas.

There have long been rural health care workforce shortages; however, the urgency to find real solutions has increased with the changing health care landscape. The evidence makes a compelling case to be intentional in the candidates we support and to align educational resources across multiple systems. Programs need to continually evolve, utilizing workforce data, best practices, and new technological advances. This leads the Office of Rural Health (ORH) to secure funding for therapists practicing in integrated settings and to expand loan repayment to general surgeons and providers creating access through telehealth. While access is ORH's core mission, North Carolina's rural health plan reframed the discussion around creating healthy rural communities. This will require further refinement of the critical workforce definition, and it brings to the forefront the fact that a variety of new partnerships will be key to achieving the objective of healthy rural communities.

[Monitoring of public health in the Kashagan oil and gas field].

According to explored hydrocarbon reserves the Republic of Kazakhstan (RK) is among ten top countries rich in oil deposits. In connection with the intensive development of oil and gas industry environmental protection and public health issues became subject of a great interest from both scientists ' and health practitioners ' side. Results of the study included in this article are devoted to the study of health of the population, living near the "Bolashak" installation of complex preparation of oil and gas. There is a preliminary oil refining process coming from the Kashagan field and its further export. Analysis proved air pollution to be the one of the major risk factors for the health of the residing people. In the area there are problems of fresh water supply and frequent accidents at sewage plants. Landfills for municipal solid waste does not meet sanitary standards. The health care system of Makat district is characterized by uncompleted personnel and lack of beds. Indices of the mortality rate over the study period declined by 28.8%. As a result, population growth over the study the period was characterized by a tendency to increase. In 2013 population sought medical advice due to respiratory diseases, injuries and poisoning, diseases of blood and hemopoietic organs, diseases of the skin and subcutaneous tissue and nervous system.

Blood transfusion practice: a survey in Sichuan, China.

OBJECTIVE: To get full knowledge of current conditions and development in the past seven years of clinical transfusion practice in Sichuan, China. STUDY DESIGN AND METHODS: This survey was performed by means of a questionnaire which consisted of three parts of questions including basic conditions of blood banks in the hospitals, procedures for clinical blood transfusion and the utilization of different types of blood products. Thirty-five representative hospitals from different geographic locations in Sichuan province participated in this survey. RESULTS: All of the 35 hospitals returned the questionnaires and 33 hospitals (94.3%) answered the questions completely. The blood bank information system began to be used by more hospitals from 2006 (21.21%, 7/33) to 2012 (48.48%, 16/33). Automated grouping and cross-matching systems have not been used in level 2 hospitals and only 3 level 3 hospitals used automated systems in 2012. Still less common were procedures for evaluation of blood order forms for appropriateness (2/33, 6.06%) and evaluation of appropriateness and effect of blood component transfusion (8/33, 24.2%), and all the hospitals having these procedures are level 3 hospitals. The percentage of whole blood usage in the volume of all types of blood products used decreased a lot from 7.45% in 2006 to 0.16% in 2010. Technological instruments for bedside checking are not used by any of the hospitals. CONCLUSIONS: The transfusion service degree of the hospitals in Sichuan, China, has developed a lot in the past seven years; however, there are still some problems including whole blood still being used, albeit decreasing; lack of independent blood banks within the hospitals; lack of dedicated personnel for the transfusion services; lack of education; lack of blood bank information systems and automation; lack of screening for appropriateness for blood orders. Thus, the quality control center of clinical blood transfusion (QCCCBT) of Sichuan province should help the transfusion departments to attract more investment in staffing, equipment and information system from the hospitals, enhance the training of transfusion department staffs, and emphasize the supervision of transfusion department's work on directing clinical blood utilization and evaluating clinical transfusion appropriateness.

A Participatory Regional Partnership Approach to Promote Nutrition and Physical Activity Through Environmental and Policy Change in Rural Missouri.

BACKGROUND: Rural residents are less likely than urban and suburban residents to meet recommendations for nutrition and physical activity. Interventions at the environmental and policy level create environments that support healthy eating and physical activity. COMMUNITY CONTEXT: Healthier Missouri Communities (Healthier MO) is a community-based research project conducted by the Prevention Research Center in St. Louis with community partners from 12 counties in rural southeast Missouri. We created a regional partnership to leverage resources and enhance environmental and policy interventions to improve nutrition and physical activity in rural southeast Missouri. METHODS: Partners were engaged in a participatory action planning process that included prioritizing, implementing, and evaluating promising evidence-based interventions to promote nutrition and physical activity. Group interviews were conducted with Healthier MO community partners post intervention to evaluate resource sharing and sustainability efforts of the regional partnership. OUTCOME: Community partners identified the benefits and challenges of resource sharing within the regional partnership as well as the opportunities and threats to long-term partnership sustainability. The partners noted that the regional participatory process was difficult, but the benefits outweighed the challenges. INTERPRETATION: Regional rural partnerships may be an effective way to leverage relationships to increase the capacity of rural communities to implement environmental and policy interventions to promote nutrition and physical activity.

International trends in health science librarianship part 14: East Africa (Kenya, Uganda, Rwanda).

This is the 14th in a series of articles exploring international trends in health science librarianship in the 21st century. This is the second of four articles pertaining to different regions in the African continent. The present issue focuses on countries in East Africa (Kenya, Uganda and Rwanda). The next feature column will investigate trends in West Africa. JM.

A survey of the mental health workforce in Guangdong: implications for policy and workforce planning.

OBJECTIVE: Mental illness is a major contributor to disease burden in China. Guangdong province has a population of over 104 million. This province's health information system is inadequate, especially the mental health workforce and service response. This paper describes a field survey to assess the existing mental health workforce and service capacity in Guangdong. METHOD: A total of 125 major service providers in Guangdong were identified with the capacity to treat serious mental illness at all levels of the health system. These services were approached to complete a standardised survey based on the WHO Assessment Instrument for Mental Health Systems. RESULTS: The survey identified 8498 mental health workers with 72.5% working in psychiatric hospitals. Service providers reported a treatment rate of 68.8% of a total of 430,000 people registered for treatment of severe mental illness, and only 28.4% of over a million people estimated to be experiencing severe mental illness. An inadequate mental health workforce was cited as a common barrier to treatment access. CONCLUSION: Guangdong province has a significant treatment gap for severe mental illness and a shortage in the mental health workforce. The distribution of the mental health workforce and facilities is imbalanced towards hospital care rather than community care.

Choosing a coverage probability for forecasting the incidence of cancer.

Loddon Mallee Integrated Cancer Service plays a key role in planning the delivery of cancer services in the Loddon Mallee Region of Victoria, Australia. Such planning relies on the accuracy of forecasting the incidence of cancer. Perhaps more importantly is the need to reflect the uncertainty of these forecasts, which is usually carried out through prediction intervals. Standard confidence levels (e.g., 90% or 95%) are typically employed when forecasting the incidence of cancer, but decision-theoretic approaches are available to help choose an optimal coverage probability by minimizing the combined risk of the interval width and noncoverage of the interval. We proceed with the decision-theoretic framework and discuss some general strategies for defining candidate loss functions for forecasting the incidence of cancer, such as the data we analyze for the Loddon Mallee Region.

Target prioritization and strategy selection for active case-finding of pulmonary tuberculosis: a tool to support country-level project planning.

BACKGROUND: Despite the progress made in the past decade, tuberculosis (TB) control still faces significant challenges. In many countries with declining TB incidence, the disease tends to concentrate in vulnerable populations that often have limited access to health care. In light of the limitations of the current case-finding approach and the global urgency to improve case detection, active case-finding (ACF) has been suggested as an important complementary strategy to accelerate tuberculosis control especially among high-risk populations. The present exercise aims to develop a model that can be used for county-level project planning. METHODS: A simple deterministic model was developed to calculate the number of estimated TB cases diagnosed and the associated costs of diagnosis. The model was designed to compare cost-effectiveness parameters, such as the cost per case detected, for different diagnostic algorithms when they are applied to different risk populations. The model was transformed into a web-based tool that can support national TB programmes and civil society partners in designing ACF activities. RESULTS: According to the model output, tuberculosis active case-finding can be a costly endeavor, depending on the target population and the diagnostic strategy. The analysis suggests the following: (1) Active case-finding activities are cost-effective only if the tuberculosis prevalence among the target population is high. (2) Extensive diagnostic methods (e.g. X-ray screening for the entire group, use of sputum culture or molecular diagnostics) can be applied only to very high-risk groups such as TB contacts, prisoners or people living with human immunodeficiency virus (HIV) infection. (3) Basic diagnostic approaches such as TB symptom screening are always applicable although the diagnostic yield is very limited. The cost-effectiveness parameter was sensitive to local diagnostic costs and the tuberculosis prevalence of target populations. CONCLUSIONS: The prioritization of appropriate target populations and careful selection of cost-effective diagnostic strategies are critical prerequisites for rational active case-finding activities. A decision to conduct such activities should be based on the setting-specific cost-effectiveness analysis and programmatic assessment. A web-based tool was developed and is available to support national tuberculosis programmes and partners in the formulation of cost-effective active case-finding activities at the national and subnational levels.

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

BACKGROUND: Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed. METHODS: The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups. RESULTS: Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan. CONCLUSIONS: Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

[The Hessian care monitor. Transparency on regional labor markets]. / Der Hessische Pflegemonitor. Transparenz über regionale Pflegearbeitsmärkte.

The Hessian Care Monitor is a Web-based monitoring system of the regional care labor market. It contains information on the current labor market and on future developments. Official statistics are analyzed, primary data are collected, and forecasts are calculated. Since 2008, the demand for nurses in Hesse has been higher than the supply. In 2010, there was a lack of more than 4,400 nurses. Moreover, in 2025, around 5,500 additional nurses will be needed to meet the increasing demand arising from demographic changes. However, there are three different regional patterns: regions with high current shortages but little additional demand in the future; regions with low current shortages but large future needs; and regions with high current shortages and large future demand. Appropriate strategies for handling labor shortages have to be selected according to the different regional patterns.

[DPC data based situation analysis of Regional Core Hospital: an application of the GIS Methodology for Regional Health Care Plans].

Each prefectural government must formulate a Regional Health Care Plan (RHCP) which will be enforced from 2013 to 2017. During this period, in Health Care Regions (HCRs) where the population is less than 200,000, the inflow rate of inpatients is less than 20%, and the outflow rate of inpatients is more than 20%, each prefecture is required to reconsider the size of any such secondary HCR. They should consider natural conditions such as geographical characteristics, social conditions such as traffic, patient flow of each area, access time to core hospitals, et cetera. In this study, we analyzed the situation of the Kiso secondary HCR of Nagano prefecture, based on the 2010 Diagnosis Procedure Combination (DPC) data that was distributed by the Ministry of Health, Labour and Welfare. According to a Geographic Information System (GIS) analysis, the Kiso HCR is self-sufficient for most emergency care and cancer treatments, even though this area is classified as a rural HCR. As this research indicates, DPC data is a useful resource for HCR planning.